Monday, June 10, 2013

Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation – Part 4

Hey check it out I'm posting on a Monday again! 

Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation – Part 4
Tess Wilkinson-Ryan, A.B.; Drew Westen, Ph.D.


DISCUSSION

The aim of this study was to formulate a more precise conception of identity disturbance, particularly in patients with borderline personality disorder. The 35 items on our identity disturbance questionnaire discriminated 1) patients with and without identity disturbance across the entire cohort, and 2) patients with and without borderline personality disorder. Four factors emerged from the factor analysis, each encompassing a distinct facet of identity disturbance.

1.      The first factor, role absorption, describes over-identification with a specific role or group membership, such that a limited role or label defines the person’s whole identity.

-          This is what happens when I talk about mirroring the actions of others or groups. Subconsciously or purposefully taking on the identity of the people around you, to garner their favor. I’ve never really done this to the extent that it’s taken over my whole identity, but I’m sure it could for some.

2.      The second factor, painful incoherence, deals with patients’ subjective experience of their own identity. This factor conveys distress or concern about identity incoherence or lack of a coherence sense of self.

-          This is often our traditional sense of Emptiness, Hollowness and Boredom. That utterly distressing sense of nothingness. At the same it could also be the sense that we can feel torn between being so many different things depending on where we are.
-          This was the most highly recorded. #1.

3.      The third factor, inconsistency, includes items such as "beliefs and actions often seem grossly contradictory."

-          This is something I know a lot of our Loved Ones are confused by. We can often send mixed messages and do things that seem wildly out of character from one minute to the next. Sometimes I think this is an attempt to figure out who we are, sometimes I think it’s dependent on who we’re with, picking up on the whims of others.
-          This was second most. #2.

4.      The final factor, lack of commitment, is a fundamental element of Marcia’s conception of identity. This factor includes patients’ difficulties in committing to goals or maintaining a constant set of values.

-          This one isn’t actually my issue but I know it is for a lot of people. Especially when it comes to those of us that don’t function so highly and Act Out with less control over our mood swings and temper.
-          This was third most. #3.


All four factors were associated with clinicians’ present/absent ratings of identity disturbance, further corroborating validity of the measure. Painful incoherence was most highly associated with presence of identity disturbance, followed by the inconsistency factor, and then by the lack of commitment factor. The four factors together (R=0.61) predicted more than a third of the variance in presence/absence of the DSM-IV identity disturbance criterion (36.7%). When a continuous rating of identity disturbance was used, the four factors predicted almost half of the variance (47.3%).

While these are the 4 factors that were measured, these are by NO means the only things that contribute to identity disturbance in BPD. Scientific studies need to be limiting in nature in order to be study-able.

Oddly of the he one that distresses me the most is the one that ranks last.


Identity Disturbance in Borderline Personality Disorder

Each of the identity disturbance factors distinguished patients with borderline personality disorder from those with other personality disorders as well as those with no personality disorder. In general, subjects with borderline personality disorder had higher scores on all of the factors, which suggests that each type of identity disturbance is more severe in patients with borderline personality disorder than is seen in other nonpsychotic psychiatric disorders. Furthermore, the contrast analysis indicated a linear relationship, such that identity disturbance on each factor was greater for patients with borderline personality disorder than for those with other personality disorders, and greater for patients with other personality disorders than for patients without personality disorders.

It’s probably not surprising but results show that compared to people with other personality disorders people with BPD have a greater disturbance of identity. Even greater than that is the difference in identity disturbance when compared to people with not personality disorder at all. This will definitely contribute to why it’s so difficult for our non personality disordered loved ones to relate to the plight we deal with sometimes. Our perspectives are really just completely differently on a different plane of existing at times.

Patients’ experience of their own identity incoherence is central to identity disturbance in borderline personality disorder; this factor was the most strongly related to borderline personality disorder in every analysis. Some theorists characterize patients with borderline personality disorder as being unaware or unconcerned about their own identity disturbances, whereas others describe these patients as being distressed by their lack of coherence. Our data support the latter point of view, although this may depend on whether the patient is more emotionally dysregulated or histrionic.

This I find interesting. Even the results of their analysis is a bit ambivalent! How Borderline! How a person experiences their own identity incoherence or coherence is crucial, plain and simple. Some people are completely unaware of their identity disturbances at all. Where others are aware and are in utter distress about it. How a person manifests their distress though is going to depend on whether they’re more emotionally dysregulated or histrionic.

The weakest of the four factors in predicting borderline personality disorder was the fourth, lack of commitment. This may be an important finding, given the heavy emphasis most identity research (as well as DSM-IV) has placed on this construct. For example, DSM-IV describes identity disturbance in borderline personality disorder as being "characterized by shifting goals, values, and vocational aspirations" (p. 651). Erikson and Marcia both describe identity diffusion as being most commonly manifested in lack of commitments to career, religion, or values. Our data indicate that while this factor is a central component of identity disturbance and is somewhat elevated in patients with borderline personality disorder, it does not distinguish borderline personality disorder from other types of psychopathology. Lack of commitment may thus be a less specific index of identity disturbance that is related to multiple forms of psychopathology and not specifically to borderline personality disorder. To what degree this reflects peculiarities of our patient group, in which occupational instability did not distinguish patients with borderline personality disorder, is unclear, and hence requires replication.

             
Hmmmm. This one I’m a little dubious about personally. I know many Borderlines that tell me they have a hard time with commitment and keeping a job, so I’m sure there is some validity to this. But at the same time I wonder how much of this is culturally imposed on us as a necessary thing. Many people go through life not knowing what they want to be when they grow up, bouncing from one job to another without a formal career. Or explore different religions or spiritualties, pulling from one or another to form their own eclectic mantra. As we grow often our values change. We learn new things, who we are, who we think we are, were, changes. I know I have. I’m glad for it. Life is an evolution of change over time after all so I’m not really sure about all of this as a matter of psychosis. Just because some doctor says I should have my entire future figured out by the time I’m 30 does it mean he’s really right and that I’m crazy for not having a solid idea of what I want by then? Hell, my idea of what I want for my future is always changing, and why not? I have the luxury of it because I have a solid well-paying job and no children. I’ll do what I want thanks.


Sexual Abuse, Borderline Personality Disorder, and Identity Disturbance

One of the goals of this research was to disentangle the role of sexual abuse history in borderline identity disturbance. In the present study, half of the borderline patients had a history of sexual abuse (in comparison with 11.5% of the subjects without borderline personality disorder), which allowed us to examine the relation between identity disturbance and borderline personality disorder while holding sexual abuse constant. The data suggest that sexual abuse contributes to only one aspect of borderline identity disturbance and does not account for all of the variance on even that aspect.

Interesting. Very, very interesting. A history of sexual abuse really only affects one main area of identity disturbance? And doesn’t even account for all of the variance in that aspect. The extrapolation being BPD symptoms would exist even without a history of sexual abuse, though potentially not as severely or in the same way.

Many researchers have found a strong relationship between a history of sexual abuse and dissociative symptoms. Sexual abuse history was highly correlated primarily with the painful incoherence factor, and the item content of this factor suggests that sexual abuse history may play a role in the more dissociative aspects of identity disturbance.

This makes a lot of sense to me. I don’t recall dissociative symptoms before my history of sexual abuse but it sure explains it afterwards. I very vividly recall the emptiness, the hollowness and a lot of the other painful feelings I felt before it though. So some of the painful incoherence factor was definitely already there, and not only from that history, but it certainly may have exacerbated it. And I wouldn’t be surprised if my dissociative disorder was a product of my history of abuse.

Although the painful incoherence factor was strongly associated with a sexual abuse history, the model that best predicted subjects’ scores on this factor included both abuse history and borderline diagnosis. The patient’s painful concern about identity incoherence is not only the result of trauma; it appears to be integral to the nature of borderline personality disorder, whether or not the patient has an abuse history. Sexual abuse was largely uncorrelated with the other three identity factors, all of which are associated with borderline personality disorder.
           
It’s interesting to me. I can be incredibly ambivalent about my identity at times. Sometimes I know. I’m sure. Other times I don’t care. No. I think it just doesn’t matter. Who are any of us anyways but specs of atoms pulled together for a short period of time until the Universe blows us away. Then other times, I just can’t wrap my mind around all the aspect that hold me together and make me a solid composition.

I’m everything and I’m nothing and none of it really matters in the end.  



            ….. and with that I’m drained. We’ll wrap this up tomorrow! 




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